Permit CITY TIGARD PLUMBING PERMIT
it DEVELOPMENT SERVICES PERMIT #: PLM2004 -00139
,.� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/3/2004
SITE ADDRESS: 16260 SW 108TH AVE PARCEL: 2S115AA -00400
SUBDIVISION: WILLOWBROOK FARM ZONING: R -25
BLOCK: LOT: 035 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: 380 ft
WATER CLOSETS: WATER LINE: 120 ft
DISHWASHERS: RAIN DRAIN: 300 ft
Remarks: Private site utilities for new minor land partition.
FEES
Owner:
Description Date Amount
SWARTWOOD, JACK A GRACE E
16260 SW 108 [PLUMB] Permit Fee 4/30/2004 $460.00
TIGARD, OR 97223 [TAX] 8% State Surchari 4/30/2004 $36.80
[PLMPLN] Plan Review 4/30/2004 $115.00
Phone : Total $611.80
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Sewer Inspection
Storm Drain Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 -001 -: - : 4. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 .99. ,
Issu - d By: _ i ��1� Permittee Signature:
Call (503) 639 75 by 7:00 P.M. for an inspection needed the next business day
Site Utilities 6.04-7z ititifc R,h{
k 1
;* � a FOR OFFICE USE ONLY
Flumbitig Perrr� f,
City of Tigard C� id 0 O R c�
Received
DateBy: Q 140 Permit No.: [�/ .• ay 1
13125 SW Hall Blvd., Tigard, O' Pt O Plan Review /� I
Phone: 503.639.4171 Fax: 503.' .0 O rc /gii I `;� Ii gill Date/By: Ai i 1 i hL Other Permit No.m(,Pav3 '
ll�ObO
24- Hour Inspection Line: 503.639.4175 F AGAR N I I,, Date Ready/By: Juris ® See Page 2 for
Internet: www.ci.tigard.or.us ,��(0 ' v100 Notified/Method: Supplemental Information
'' N . ' t ° E • " ..`r. ° )�' Y , t, . „ 0 ' ,r � j , . FEE* SCHEDULE
[� New ons
c truct o ❑Demolition For special information use checklist
Description I Qty, Ea. I Total
❑ Addition/alteration/replacement ❑ Other: , New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
s 3
-R %z y g n s e. SFR (1) bath 249.20
4 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building 1:1 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
'`; Fire sprinkler sq. ft) Page 2
,ems �,:. ''
i r . : ..���x. �� s.�, ..,.._vs •. war ., A: M S utilities
iii A
Job site address: / 4 40 S, . / Q c �, , Catch basin or area drain 16.60
7 City/State /ZIP: 7 L 04 9 7,2j,./ / / / /� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name�W 0.Y - t tA1 o d a rt 1_a r , T //; Footing drain (no. linear ft.: ) Page 2
Oh Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes I 16.60 ) (, 6 o
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) 380 Page 2 I99:
Storm sewer (no. linear ft.: ) 300 Page 2 _ /t.'7. 9
Subdivision: I Lot no.: Water service (no. linear ft.: _) 4.1 0 Page 2 /0/,../0
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
� - � ,� �.,� �� -.�� � �. _ - Backflow preventer Page 2
1,J 0.44_ 4.- SQawi Q. r Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
... � ' �;
' E jectors / sump 16.60
Name: a ® TICA. c..-V_ race_ C.e_ S I Ja r r) 00. Expansion tank 16.60
Address: / ! 2. Co S .w /0X' 1t 1 „p - , Fixture/sewer cap 16.60
City/State /ZIP: 7 ' l am. a - I Q p , /T 4, 7 .21 F drain /floor sink/hub 16.60
Phone: ('a3 , 3 ... • , • Fax: ( ) Garbage disposal 16.60
' � R, Hose bib 16.60
' � , Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
Tub /shower /shower pan 16.60
E-mail:
Urinal 16.60
� ., - . , .>r,. § t „, Water closet 16.60
Business name: l. Water heater 16.60
Address: Other:
Subtotal
City/State/ZIP: //6(,
Minimum permit fee: $72.50 ; -
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 . •
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) /(I 00
State surcharge (8% of permit fee) 36. S0
Authorized signature:
TOTAL PERMIT FEE 6/4 g(0 Print name: C.,.'CQCQ S u jAc hp 00 k Date> jf J D Th is permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
/Jo `eg 5 4 - 7 - / jTq. K £ C T3 O` ,014. *Fee methodology set by Tri-County Building Industry Service Board.
i:'Building\Pemats\PLMU- PermitApp.doc 12/03 i 44 0- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
r
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Uti lities Qtr Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200
$220.00
Sewer - 1st 100' / 55.00 -,
/ 7� 7,201 and greater $309.00
Sewer - each additional 100' ? 46.40 /sq. )o
Water Service - 1st 100' 55.00 i
1 "'� Medical Gas Systems:
Water Service - each additional 100' 46.40 1.4 1-0
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00
J.5'7 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 9 2 vV $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. fee (e),... Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or • and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees.
Quanti[y by (Fixture)- WOikPerforrned
Re lace
F,xtureType Moved, Existin ' Capped Com ments regarding fixture work:
New... g g
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial - *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service -
Swimming Pool Filter -
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal _
Other Fixtures:
is \ Building \Pemiits\PLM- PermitApp.doc 3/03
OY .
00 ROTOM
cy) 2 5599 S.W. 95 th Ave., Ste. B • •Wilsonville, OR 97070 INVOICE G N 029829
N
aLOOTERn (503) 682 9774 •FAX (503) 685 9754 •Salem (503 581 0236 OR ST CONTR # 13989 • WA ST CONTR # ROTOR ** 088JG -�^7 C7 P LUMBERS DATE ( "2( .v
z __
0 11111. 1- 800 =SET ROTO (438 -7686) www, rotorooter,com JOB # 1 TECHNICIAN 2 - 9 4 - - fT -, - - --
CUSTOMER: NAME
_.--
NAME (.71 - , • ' / "') \*' -) / . .J_D. 0 0 ADDRESS J ( 2
JOB ADDRESS / G> a 6 � �/ , - i� 1
ti r—" STATE ^'
�.V'�� �� ! . CITY
�' -)Ll .
CITY STATE 0 r, PHONE NO. ( ) ZIP CODE ,
PHONE NO. ( ) < ZIP CODE r- 77 7 ❑ YES GUARANTEE NO ❑ TIME IN TIME OUT / • (»
COURTESY INSPECTION 0 ON -\ I ACCESSED VIA CAUSE OF STOPPAGE -. l- LI OVERTIME $
❑ DRAIN ❑ CLEAN OUT ❑ ROOTS ❑ GREASE
X } ' ❑ VENT ❑ OTHER ❑ UNKNOWN J DRAIN CLEANING
FIXTURE OK NEED $ AUTH. DESCRIPTION / REMARKS ADDITIONAL FOOTAGE
SERV.
MAIN LINE ADD'L FIXTURES
TOILET ' PLUMBING LABOR
BATH TUB PARTS '.
SHOWER EXCAVATION
BATH SINK PRODUCTS
KITCHEN SINK VIDEO INSPECTION
DISPOSAL HYDRO- JETTER
LAUNDRY MINI JETTER
URINAL PARTS LINE/ LEAK LOCATION
FLOOR DRAIN QTY. PART NO DESCRIPTION PRICE
FLOOR SINK z TAX
AREA DRAIN TOTAL
WATER HEATER PAYMENT RECEIVED
BALANCE DUE
I hereby authorize the above described work to be performed by Roto-Rooter and agree to all of the terms and conditions set forth above and on the ❑CASH ❑ CHG ❑ CK #
reverse side hereof. I recognize that aged deteriorated plumbing fixtures or piping, settled, broken or off-set sewer lines may no longer be serviceable and
further agree to hold Roto-Rooter harmless for any damage or destruction thereto or arising therefrom. I agree to pay for all work, goods, and services LI CREDIT CARD / AUTH. # 1 r
received in accordance with the terms stated herein.
TERMS: Net 10 days. An account maintenance fee of 1 1/2% of the outstanding balance per month (18% annual percentage rate) will be added to CC #
amounts not paid within 30 days of invoice date. A $20,00 charge is added for all returned checks. / CLEAN UP \
\ EXCELLENT ❑ SATISFACTORY ❑ POOR
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS SHEET. �,/ f
FILE COPY X �GI- v—C C, /vt: .t'
SIGNATURE (ACCEPTANCE OF ESTIMATE) SIGNATURE (ACKNOWLEDGEMENT OF COMPLETION)
a J I J I Irr1FJ�0.0.1PclPrJ c?.!'MINIt JtcPr.l?JPc [?2J ' rJPLrJE MPc Pr Pt.PLPETOPr�rnr..fr�r P.trJ�LEPrrJ�rPLEPEEPEI PLEPLIEPLE Jar r a
5 4Arst-brnitai � xxx 5 t
1
5
5 1. Basin, Tub, Shower, Kitchen Sink Laundry and Sewer in Good Condition with Clean Out .. .120 days 5
5 2. Sewer From Roof Vent `:,;; 60 days I�
g . 3. Toilet Stoppage and Area Drain 1 D days
gl 4. All Plumbing, Repairs and Replacements ............ 1 Year Parts & Labor S
o TEREr�rJ�r PLIEPLL PLEEPrPE l�EPERrldJ�rlr LEPLPE-Prte c1rJ clMtPLPr1rJ�r cPr.Pr.JcPrJPJ�rJOMPLcJE�.Pr. Pr�irrlP�PcPr��PJERPda r1 a
CONDITIONS AND .EXCLUSIONS
f
Roto- Rooter Service & Plumbing Co. guarantees the services performed as set forth in this invoice to be free from defect in materials or
workmanship for the applicable time period stated above. If within the Guarantee Period a drain stoppage or other defect in the repair of plumbing
fixtures or plumbing parts installed by Rote- Rooter Service & Plumbing Co. occurs, Rota - Rooter Service & Plumbing Co. will clear the drain stoppage
or. repair or replace (at Roto- Rooter Service & Plumbing Co.', option) the plumbing fixture or plumbing part previously installed at no cost to customer,
subject to the following exclusions and limitations:
1. This Guarantee applies only to the specific sewer lines c leaned. or plumbing fixtures or plumbing parts supplied and installed by Roto- Rooter
Service & Plumbing Co.
2. Roto- Rooter Service & Plumbing Co. must receive notice of the defect within the Guarantee Period.
3. ' This Guarantee does not apply to:
a. Coniinercial or Industrial sewer and drain luxes. plumbing fixtures or plumbing parts.
b,- Materials furnished or work performed by other than Row- Rooter Service & Plumbing Co.
c. Drains, sewer lines, plumbing fixtures and plumbing parts which have been misused, abused, damaged or modified by others;
d. Drain or sewer line stoppages caused by foreign objects, including hut not limited to sanitary articles, paper towels, toys, etc.; or
e. Sewer lines which are settled, broken, offset deteriorated, damaged or improperly or itlegiil installed.
4. The Guarantee Period commences on the date or original service and shall not be extended by subsequent services or repairs made pursuant to
the terms of the Guarantee. The Guarantee hereunder extends to ttte customer invoiced for the services and is not transferable.
5. Rota- Rooter Service & Plumbing Co.'s liability hereunder shall be limited to recleaning of drain or sewer stoppage or the repair or replacement
of defective plumbing fixtures or plumbing parts: Roto- Rooter Service & Plumbing Co. shall not be liable for (1) Incidental or consequential damages;
(2) Water or other damage; (3) Loss of use; or (4) Lass of anticipated beneftts'orprofits, any of which result from the furnishing of services or products.
or from the breach of the Guarantee, even if Roto- Rooter Service & Plumbing co. knew of the likelihood of such damages.
6. Any implied warranty of merchantability, or fitness for a particular purpose of use, shall be limited to the duration of=the foregoing written
guarantee. The foregoing written guarantee is the customer's sole and exclusive remedy and in lieu of all other guaranties and warranties, express or
implied, written or oral. This guarantee may only be modified in writing, signed by an officer of Roto - Rooter Service & Plumbing Co.
7. This guarantee does not apply in the event customer breaches any of the Terms and Conditions of service, including but not limited to timely
payment of all charges. •
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST s
INSPECTION DIVISION Business Line: (503) 639-4171 ) BUP
Received " /�1 Date Requested C / AM PM BUP
Location / �0 4O 5) to -- Suite MEC
Contact Person , Ph ( ) PLM c 2 .O O S —0-0 / 39
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � lr SIT
Post & Beam 5P. �' �"6�1�vy1 {l
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PA ART FAIL
UMBIN
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma ole
Storm Drain
Shower Pan
Other:
in
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
. Q
CITY OF TIGARD 24 -Hour' - .
-`• BUILDING Inspection Line: (5031639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
77 - BUP
Received Date Requested Gi -)? AM - PM BUP
Location I -K O 5LA-) f 0 ( (4fAP- - Suite MEC -
Contact Person = a- C - &- -- Ph ( ) PLM - �
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation .. ,V, ,r;*yr : %t' � =a'.::o)' ji. 2 ' '�(". ELC
Ftg Drain ' -' ' ,, i. ;7.: 'k. N, H 1 p.f 7' �'. ti',r a . � �
Crawl Drain �,' �..._ Zr: �f' :1 .' .1 : ;. _ _ >+ 1 , = • ...1 ± t -� ?: .1 ::. f
Slab Inspection Notes: SIT
Post & Beam . tiS !n • - 34 I, 'ti "- (.- I
Shear Anchors
Ext Sheath/Shear
., - Int Sheath/Shear / •
" Framing
Insulation /
Drywall Nailing I
Fire Sprinkler /
Fire Alarm
Susp'd Ceiling
4 ! r a
Roof ,r" .
Other: t
•.‘" Final
PASS FAIL • PLUMBING) "- t :' 1
Post" &°Beam
Under Slab / ;
- Rough -In
Water Service
/
Sanitary Sewer
Rain Drains I ,
Catch Basin /.Manhole
Storm -Drain " /_
Shower Pan
[Other
Final . ks
°;PASS} PART FAIL •
MECHANICAL
Post &Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
-
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line , / " . z
ADA .. ,
Approach /Sidewalk Date , Inspector ` . `" ' Ent
.
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL